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Simply More (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply More (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply More (HMO) in 2026, please refer to our full plan details page.
Simply More (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply More (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply More (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Simply More (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $35.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3850.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Simply More (HMO) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 6 supplemental drugs. This $0 cost sharing applies to one-, two-, and three-month supplies at preferred, standard, and standard mail-order pharmacies. For Tier 4 non-preferred drugs, a one-month supply costs a $30 copay at preferred and standard mail-order pharmacies, or a $35 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Simply More (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. Outpatient hospital services and diagnostic tests feature low out-of-pocket costs, ranging from no copay to a $50 copay, while emergency room visits require a $75 copay. If you need skilled nursing facility care, there is no copay for the first 20 days and a $60 daily copay for days 21 through 100. Additionally, the plan features robust routine dental, vision, and hearing benefits with no copay or coinsurance, including allowance limits for eyewear and hearing aids. Members also enjoy no-cost perks like unlimited transportation to plan-approved locations and a monthly $37 allowance for over-the-counter items. Essential services like dialysis and durable medical equipment are covered with no copay and a coinsurance of up to 20 percent.
Inpatient Hospital See details
Simply More (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. While three additional days of acute care are covered, non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Simply More (HMO) covers outpatient services with no coinsurance, offering a $0 to $50 copay for outpatient hospital services and a $50 copay for observation and substance abuse services. Ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Simply More (HMO) plan with no copay and no coinsurance. Both prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Simply More (HMO) covers ground ambulance services with a $75 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay and no coinsurance, though trips to other health-related locations are not covered.
Emergency Services See details
Simply More (HMO) covers emergency services with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $75 copay and no coinsurance up to a $100,000 maximum benefit.
Primary Care See details
Simply More (HMO) primary care benefits feature no copay and no coinsurance for primary care, specialist visits, therapy, and telehealth, while opioid treatment requires a $50 copay and no coinsurance. Chiropractic services are not covered under this plan, and several covered services require a referral or prior authorization.
Preventive Services See details
Simply More (HMO) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits like Medicare-covered preventive care, kidney disease education, glaucoma screenings, and memory fitness. However, some sub-services are not covered, including annual physical exams, medical nutrition therapy, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Simply More (HMO), offering routine hearing exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance. While there is a $2,000 annual maximum benefit for prescription hearing aids, OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Simply More (HMO) features partially covered vision benefits with no copay, no coinsurance, and no deductible for routine eye exams and eyewear, which includes a $350 annual allowance. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Simply More (HMO) with no copay and no coinsurance for preventive and comprehensive care up to a $1,200 annual maximum. Prior authorization is required for many comprehensive treatments, and implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply More (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Simply More (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply More (HMO) covers medical equipment with no copays across all categories, although prior authorization is required. Durable medical equipment incurs a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are provided with no coinsurance.
Diagnostic and Radiological Services See details
Simply More (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay of $0 to $25, and diagnostic and therapeutic radiological services carry a minimum $0 copay.
Home Health Services See details
Home Health Services are covered by Simply More (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Simply More (HMO) with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. While a prior three-day hospital stay is not required, prior authorization and referrals are necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
Simply More (HMO) provides select other services with no copay and no coinsurance, including a chronic illness meal benefit and up to $37 monthly for over-the-counter (OTC) items. Acupuncture and other additional services are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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